947. Test of cure for Neisseria gonorrhoeae (NG) among men who have sex with men (MSM):  results of a pilot study
Session: Poster Abstract Session: Sexually Transmitted Infections
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 947_Levy_IDSA2013_poster_Final.pdf (100.7 kB)
  • Background:

    In California in 2011, 32 cases of Neisseria gonorrhoeae with NG-MAST ST1407 (Neisseria gonorrhoeae Multiantigen Sequence Typing) were identified.  ST1407 has been shown to possess higher MICs to third generation cephalosporins and have been associated with treatment failures in Europe. To identify potential treatment failures, test of cure (TOC) for MSM with NG has been recommended by the Centers for Disease Control and Prevention.  However, feasibility of implementing routine TOC among MSM is unknown. We present initial findings from a NG TOC project in a Northern California county public STD/HIV clinic that performs routine NG screening among MSM.

    Methods:

    MSM with NG detected by nucleic acid amplification test (NAAT) from urine, rectum or pharynx were recruited.   All were treated with ceftriaxone 250mg IM and azithromycin 1gm orally and encouraged to return for a post-treatment TOC at 7-10 days.  At the TOC visit, NAAT and culture swabs were obtained. We defined NG treatment failure as a positive test of cure with NAAT or culture in the absence of sexual re-exposure.

    Results:

    22 MSM with NG infection were offered TOC. Over half of men were HIV-infected (13/22). Most infections were asymptomatic (16/22) and all involved the pharynx and/or rectum (10/22 pharynx only, 4/22 pharynx and rectum, 7/22 rectum only) with no urogenital infections. Over two thirds of MSM (15/22) returned for a TOC. One potential NG treatment failure was identified in an HIV-negative man reporting oral sex with a European backpacker in California three weeks prior to NG diagnosis.  Day of treatment pharyngeal specimen yielded a positive NAAT specimen and detection of ST1407 by DNA sequencing. Day 7 TOC in this case showed persistently positive pharyngeal NG NAAT with a negative culture. On day 14, the patient was re-treated with ceftriaxone 500mg IM and azithromycin 2gm orally. A second TOC on day 34 was NAAT negative for NG infection. 

    Conclusion:

    Routine TOC for NG appears acceptable to MSM.  Further studies are needed to determine whether positive NAAT TOCs with negative culture represent true treatment failure.  Current surveillance systems for NG resistance only employing urogenital specimens may underestimate prevalence of antibiotic resistance.

    Vivian Levy, MD1, Mark Pandori, PhD2, Zenda Berrada, PhD3, Karen Relucio, MD1, Michael Samuel, DrPH4 and Ina Park, MD, MS5, (1)San Mateo County Health System, San Mateo, CA, (2)San Francisco Department of Public Health, San Francisco, CA, (3)San Mateo County Public Health Laboratory, San Mateo, CA, (4)University of California, San Francisco, Obstetrics, Gynecology and Reproductive Health Services, San Francisco, CA, (5)University of California, San Francisco, Department of Family and Community Medicine, San Francisco, CA

    Disclosures:

    V. Levy, None

    M. Pandori, None

    Z. Berrada, None

    K. Relucio, None

    M. Samuel, None

    I. Park, None

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